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Gray Facial Plastic Surgery, PLLC

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Company Details

Name: Gray Facial Plastic Surgery, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 01 Aug 2024 (a year ago)
Financial Date End: 31 Aug 2025
Entity Number: 5835839
Place of Formation: IDAHO
File Number: 948729
ZIP code: 83616
County: Ada County
Principal Address: ALAN GRAY APT 3036 17777 N SCOTTSDALE RD SCOTTSDALE, AR 85255
Mailing Address: ALAN GRAY, MD STE 170 868 E RIVERSIDE DR EAGLE, ID 83616-6025

Agent

Name Role Address
Alan J Gray Agent 868 E RIVERSIDE DR, STE 170, EAGLE, ID 83616

National Provider Identifier

NPI Number:
1104638451
Certification Date:
2025-02-09

Authorized Person:

Name:
DR. ALAN JAMES GRAY
Role:
FACIAL PLASTIC SURGEON
Phone:

Taxonomy:

Selected Taxonomy:
207YS0123X - Facial Plastic Surgery Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Change of Registered Office/Agent/Both (by Entity) 0006290603 2025-06-01
Statement of Change of Business Mailing Address 0006288453 2025-05-29
Initial Filing 0005835839 2024-08-01

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Date of last update: 21 Jun 2025

Sources: Idaho Secretary of State